Foot ulceration and its association with mortality in diabetes mellitus: a meta‐analysis
Background Diabetic foot ulcers portend an almost twofold increase in all‐cause mortality compared with diabetes on its own. Aim To investigate the association between diabetic foot ulcers and risk of death. Methods We performed a meta‐analysis of all observational studies investigating the associat...
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| Veröffentlicht in: | Diabetic medicine 2020-02, Vol.37 (2), p.211-218 |
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| creator | Saluja, S. Anderson, S. G. Hambleton, I. Shoo, H. Livingston, M. Jude, E. B. Lunt, M. Dunn, G. Heald, A. H. |
| description | Background
Diabetic foot ulcers portend an almost twofold increase in all‐cause mortality compared with diabetes on its own.
Aim
To investigate the association between diabetic foot ulcers and risk of death.
Methods
We performed a meta‐analysis of all observational studies investigating the association between diabetic foot ulcers and all‐cause mortality. Risk ratios and risk differences were pooled in a random‐effects model. The I2 statistic was used to quantify heterogeneity between studies.
Results
Altogether, we identified 11 studies that reported 84 131 deaths from any cause in 446 916 participants with diabetes during a total of 643 499 person‐years of follow‐up. The crude event rate for all‐cause mortality in individuals with diabetes who did not develop foot ulceration was 22% lower at 181.5 deaths (per 1000 person‐years) than in those who developed foot ulcers (230.8 per 1000 person‐years). Diabetic foot ulceration was associated with an increased risk of all‐cause mortality (pooled relative risk 2.45, 95% CI 1.85–2.85). We did not observe any tangible differences in risk of all‐cause mortality from diagnosis in studies reporting a mean duration of follow‐up of ≤3 years (relative risk 2.43, 95% CI 2.27–2.61) or >3 years (relative risk 2.26, 95% CI 2.13–2.40) years. Funnel plot inspection revealed no significant publication bias among studies included in this meta‐analysis.
Conclusions
Our study shows an excess rate of all‐cause mortality in people with diabetic foot ulceration when compared to those without foot ulceration. It is imperative that early interventions to prevent foot ulceration and modify cardiovascular disease risk factors are put in place to reduce excess mortality.
What's new?
Diabetes mellitus increases the risk of cardiovascular disease and all‐cause mortality. There is clear evidence that diabetic foot ulceration, a common problem in long‐standing diabetes increases risk of death further still.
In this systematic review we have updated the meta‐analysis by Brownrigg et al. (2012), including almost half a million participants. We pooled study‐specific estimates using random‐effects meta‐analysis to ascertain risk of death in people with diabetes who developed foot ulceration vs those who did not. We conclude that, in the presence of diabetes, people with ulcers have an excess rate of all‐cause mortality as compared to those without any foot complications.
The presence of diabetic foot ulceration should be viewed as a major red f |
| doi_str_mv | 10.1111/dme.14151 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2305799826</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2305799826</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3531-9e1d5fa798cddfa61257116c5fee5d4da6229461da781a13ec52276a80f1b5283</originalsourceid><addsrcrecordid>eNp10M9O3DAQBnALtWK3wIEXqCz10h4CHv9JYm4VhbbSIi5w4RLNxo7qVRIvsSOUWx-BZ-yT1NssHCrhy1ijnz6NPkJOgZ1Beuems2cgQcEBWYLMZaakhndkyQrJM8EKWJAPIWwYA66FPiQLATkIyeSSPFx7H-nY1nbA6HxPsTfUxUAxBF-7effk4i_a-SFi6-JEXU-Nw7WNNtDOtmk3hguK6R_xz-9n7LGdggvH5H2DbbAn-3lE7q-v7i5_ZKvb7z8vv66yWigBmbZgVIOFLmtjGsyBqwIgr1VjrTLSYM65ljkYLEpAELZWnBc5lqyBteKlOCKf59zt4B9HG2LVuVCnu7C3fgwVF0wVWpc8T_TTf3TjxyHdu1NSiJJrLZL6Mqt68CEMtqm2g-twmCpg1a7wKhVe_Ss82Y_7xHHdWfMqXxpO4HwGT66109tJ1bebqznyL3OJimA</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2343382993</pqid></control><display><type>article</type><title>Foot ulceration and its association with mortality in diabetes mellitus: a meta‐analysis</title><source>MEDLINE</source><source>Access via Wiley Online Library</source><creator>Saluja, S. ; Anderson, S. G. ; Hambleton, I. ; Shoo, H. ; Livingston, M. ; Jude, E. B. ; Lunt, M. ; Dunn, G. ; Heald, A. H.</creator><creatorcontrib>Saluja, S. ; Anderson, S. G. ; Hambleton, I. ; Shoo, H. ; Livingston, M. ; Jude, E. B. ; Lunt, M. ; Dunn, G. ; Heald, A. H.</creatorcontrib><description>Background
Diabetic foot ulcers portend an almost twofold increase in all‐cause mortality compared with diabetes on its own.
Aim
To investigate the association between diabetic foot ulcers and risk of death.
Methods
We performed a meta‐analysis of all observational studies investigating the association between diabetic foot ulcers and all‐cause mortality. Risk ratios and risk differences were pooled in a random‐effects model. The I2 statistic was used to quantify heterogeneity between studies.
Results
Altogether, we identified 11 studies that reported 84 131 deaths from any cause in 446 916 participants with diabetes during a total of 643 499 person‐years of follow‐up. The crude event rate for all‐cause mortality in individuals with diabetes who did not develop foot ulceration was 22% lower at 181.5 deaths (per 1000 person‐years) than in those who developed foot ulcers (230.8 per 1000 person‐years). Diabetic foot ulceration was associated with an increased risk of all‐cause mortality (pooled relative risk 2.45, 95% CI 1.85–2.85). We did not observe any tangible differences in risk of all‐cause mortality from diagnosis in studies reporting a mean duration of follow‐up of ≤3 years (relative risk 2.43, 95% CI 2.27–2.61) or >3 years (relative risk 2.26, 95% CI 2.13–2.40) years. Funnel plot inspection revealed no significant publication bias among studies included in this meta‐analysis.
Conclusions
Our study shows an excess rate of all‐cause mortality in people with diabetic foot ulceration when compared to those without foot ulceration. It is imperative that early interventions to prevent foot ulceration and modify cardiovascular disease risk factors are put in place to reduce excess mortality.
What's new?
Diabetes mellitus increases the risk of cardiovascular disease and all‐cause mortality. There is clear evidence that diabetic foot ulceration, a common problem in long‐standing diabetes increases risk of death further still.
In this systematic review we have updated the meta‐analysis by Brownrigg et al. (2012), including almost half a million participants. We pooled study‐specific estimates using random‐effects meta‐analysis to ascertain risk of death in people with diabetes who developed foot ulceration vs those who did not. We conclude that, in the presence of diabetes, people with ulcers have an excess rate of all‐cause mortality as compared to those without any foot complications.
The presence of diabetic foot ulceration should be viewed as a major red flag for an increased disease burden and a poor outcome, and therefore should be prevented. If foot ulceration occurs, close monitoring of those individuals is warranted.
Continued development of clinical services towards prevention, early intervention and multidisciplinary team management is an appropriate strategy to reduce the burden in individuals with diabetes.</description><identifier>ISSN: 0742-3071</identifier><identifier>EISSN: 1464-5491</identifier><identifier>DOI: 10.1111/dme.14151</identifier><identifier>PMID: 31613404</identifier><language>eng</language><publisher>England: Wiley Subscription Services, Inc</publisher><subject>Cardiovascular diseases ; Cause of Death ; Diabetes ; Diabetes mellitus ; Diabetes Mellitus - epidemiology ; Diabetic Foot - epidemiology ; Feet ; Foot diseases ; Health risk assessment ; Humans ; Leg ulcers ; Meta-analysis ; Mortality ; Prognosis ; Risk factors ; Ulcers</subject><ispartof>Diabetic medicine, 2020-02, Vol.37 (2), p.211-218</ispartof><rights>2019 Diabetes UK</rights><rights>2019 Diabetes UK.</rights><rights>Diabetic Medicine © 2020 Diabetes UK</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3531-9e1d5fa798cddfa61257116c5fee5d4da6229461da781a13ec52276a80f1b5283</citedby><cites>FETCH-LOGICAL-c3531-9e1d5fa798cddfa61257116c5fee5d4da6229461da781a13ec52276a80f1b5283</cites><orcidid>0000-0002-9537-4050</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fdme.14151$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fdme.14151$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,780,784,1417,27924,27925,45574,45575</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31613404$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Saluja, S.</creatorcontrib><creatorcontrib>Anderson, S. G.</creatorcontrib><creatorcontrib>Hambleton, I.</creatorcontrib><creatorcontrib>Shoo, H.</creatorcontrib><creatorcontrib>Livingston, M.</creatorcontrib><creatorcontrib>Jude, E. B.</creatorcontrib><creatorcontrib>Lunt, M.</creatorcontrib><creatorcontrib>Dunn, G.</creatorcontrib><creatorcontrib>Heald, A. H.</creatorcontrib><title>Foot ulceration and its association with mortality in diabetes mellitus: a meta‐analysis</title><title>Diabetic medicine</title><addtitle>Diabet Med</addtitle><description>Background
Diabetic foot ulcers portend an almost twofold increase in all‐cause mortality compared with diabetes on its own.
Aim
To investigate the association between diabetic foot ulcers and risk of death.
Methods
We performed a meta‐analysis of all observational studies investigating the association between diabetic foot ulcers and all‐cause mortality. Risk ratios and risk differences were pooled in a random‐effects model. The I2 statistic was used to quantify heterogeneity between studies.
Results
Altogether, we identified 11 studies that reported 84 131 deaths from any cause in 446 916 participants with diabetes during a total of 643 499 person‐years of follow‐up. The crude event rate for all‐cause mortality in individuals with diabetes who did not develop foot ulceration was 22% lower at 181.5 deaths (per 1000 person‐years) than in those who developed foot ulcers (230.8 per 1000 person‐years). Diabetic foot ulceration was associated with an increased risk of all‐cause mortality (pooled relative risk 2.45, 95% CI 1.85–2.85). We did not observe any tangible differences in risk of all‐cause mortality from diagnosis in studies reporting a mean duration of follow‐up of ≤3 years (relative risk 2.43, 95% CI 2.27–2.61) or >3 years (relative risk 2.26, 95% CI 2.13–2.40) years. Funnel plot inspection revealed no significant publication bias among studies included in this meta‐analysis.
Conclusions
Our study shows an excess rate of all‐cause mortality in people with diabetic foot ulceration when compared to those without foot ulceration. It is imperative that early interventions to prevent foot ulceration and modify cardiovascular disease risk factors are put in place to reduce excess mortality.
What's new?
Diabetes mellitus increases the risk of cardiovascular disease and all‐cause mortality. There is clear evidence that diabetic foot ulceration, a common problem in long‐standing diabetes increases risk of death further still.
In this systematic review we have updated the meta‐analysis by Brownrigg et al. (2012), including almost half a million participants. We pooled study‐specific estimates using random‐effects meta‐analysis to ascertain risk of death in people with diabetes who developed foot ulceration vs those who did not. We conclude that, in the presence of diabetes, people with ulcers have an excess rate of all‐cause mortality as compared to those without any foot complications.
The presence of diabetic foot ulceration should be viewed as a major red flag for an increased disease burden and a poor outcome, and therefore should be prevented. If foot ulceration occurs, close monitoring of those individuals is warranted.
Continued development of clinical services towards prevention, early intervention and multidisciplinary team management is an appropriate strategy to reduce the burden in individuals with diabetes.</description><subject>Cardiovascular diseases</subject><subject>Cause of Death</subject><subject>Diabetes</subject><subject>Diabetes mellitus</subject><subject>Diabetes Mellitus - epidemiology</subject><subject>Diabetic Foot - epidemiology</subject><subject>Feet</subject><subject>Foot diseases</subject><subject>Health risk assessment</subject><subject>Humans</subject><subject>Leg ulcers</subject><subject>Meta-analysis</subject><subject>Mortality</subject><subject>Prognosis</subject><subject>Risk factors</subject><subject>Ulcers</subject><issn>0742-3071</issn><issn>1464-5491</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp10M9O3DAQBnALtWK3wIEXqCz10h4CHv9JYm4VhbbSIi5w4RLNxo7qVRIvsSOUWx-BZ-yT1NssHCrhy1ijnz6NPkJOgZ1Beuems2cgQcEBWYLMZaakhndkyQrJM8EKWJAPIWwYA66FPiQLATkIyeSSPFx7H-nY1nbA6HxPsTfUxUAxBF-7effk4i_a-SFi6-JEXU-Nw7WNNtDOtmk3hguK6R_xz-9n7LGdggvH5H2DbbAn-3lE7q-v7i5_ZKvb7z8vv66yWigBmbZgVIOFLmtjGsyBqwIgr1VjrTLSYM65ljkYLEpAELZWnBc5lqyBteKlOCKf59zt4B9HG2LVuVCnu7C3fgwVF0wVWpc8T_TTf3TjxyHdu1NSiJJrLZL6Mqt68CEMtqm2g-twmCpg1a7wKhVe_Ss82Y_7xHHdWfMqXxpO4HwGT66109tJ1bebqznyL3OJimA</recordid><startdate>202002</startdate><enddate>202002</enddate><creator>Saluja, S.</creator><creator>Anderson, S. G.</creator><creator>Hambleton, I.</creator><creator>Shoo, H.</creator><creator>Livingston, M.</creator><creator>Jude, E. B.</creator><creator>Lunt, M.</creator><creator>Dunn, G.</creator><creator>Heald, A. H.</creator><general>Wiley Subscription Services, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>8FD</scope><scope>FR3</scope><scope>H94</scope><scope>K9.</scope><scope>P64</scope><scope>RC3</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-9537-4050</orcidid></search><sort><creationdate>202002</creationdate><title>Foot ulceration and its association with mortality in diabetes mellitus: a meta‐analysis</title><author>Saluja, S. ; Anderson, S. G. ; Hambleton, I. ; Shoo, H. ; Livingston, M. ; Jude, E. B. ; Lunt, M. ; Dunn, G. ; Heald, A. H.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3531-9e1d5fa798cddfa61257116c5fee5d4da6229461da781a13ec52276a80f1b5283</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Cardiovascular diseases</topic><topic>Cause of Death</topic><topic>Diabetes</topic><topic>Diabetes mellitus</topic><topic>Diabetes Mellitus - epidemiology</topic><topic>Diabetic Foot - epidemiology</topic><topic>Feet</topic><topic>Foot diseases</topic><topic>Health risk assessment</topic><topic>Humans</topic><topic>Leg ulcers</topic><topic>Meta-analysis</topic><topic>Mortality</topic><topic>Prognosis</topic><topic>Risk factors</topic><topic>Ulcers</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Saluja, S.</creatorcontrib><creatorcontrib>Anderson, S. G.</creatorcontrib><creatorcontrib>Hambleton, I.</creatorcontrib><creatorcontrib>Shoo, H.</creatorcontrib><creatorcontrib>Livingston, M.</creatorcontrib><creatorcontrib>Jude, E. B.</creatorcontrib><creatorcontrib>Lunt, M.</creatorcontrib><creatorcontrib>Dunn, G.</creatorcontrib><creatorcontrib>Heald, A. H.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>Technology Research Database</collection><collection>Engineering Research Database</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>Genetics Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>Diabetic medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Saluja, S.</au><au>Anderson, S. G.</au><au>Hambleton, I.</au><au>Shoo, H.</au><au>Livingston, M.</au><au>Jude, E. B.</au><au>Lunt, M.</au><au>Dunn, G.</au><au>Heald, A. H.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Foot ulceration and its association with mortality in diabetes mellitus: a meta‐analysis</atitle><jtitle>Diabetic medicine</jtitle><addtitle>Diabet Med</addtitle><date>2020-02</date><risdate>2020</risdate><volume>37</volume><issue>2</issue><spage>211</spage><epage>218</epage><pages>211-218</pages><issn>0742-3071</issn><eissn>1464-5491</eissn><abstract>Background
Diabetic foot ulcers portend an almost twofold increase in all‐cause mortality compared with diabetes on its own.
Aim
To investigate the association between diabetic foot ulcers and risk of death.
Methods
We performed a meta‐analysis of all observational studies investigating the association between diabetic foot ulcers and all‐cause mortality. Risk ratios and risk differences were pooled in a random‐effects model. The I2 statistic was used to quantify heterogeneity between studies.
Results
Altogether, we identified 11 studies that reported 84 131 deaths from any cause in 446 916 participants with diabetes during a total of 643 499 person‐years of follow‐up. The crude event rate for all‐cause mortality in individuals with diabetes who did not develop foot ulceration was 22% lower at 181.5 deaths (per 1000 person‐years) than in those who developed foot ulcers (230.8 per 1000 person‐years). Diabetic foot ulceration was associated with an increased risk of all‐cause mortality (pooled relative risk 2.45, 95% CI 1.85–2.85). We did not observe any tangible differences in risk of all‐cause mortality from diagnosis in studies reporting a mean duration of follow‐up of ≤3 years (relative risk 2.43, 95% CI 2.27–2.61) or >3 years (relative risk 2.26, 95% CI 2.13–2.40) years. Funnel plot inspection revealed no significant publication bias among studies included in this meta‐analysis.
Conclusions
Our study shows an excess rate of all‐cause mortality in people with diabetic foot ulceration when compared to those without foot ulceration. It is imperative that early interventions to prevent foot ulceration and modify cardiovascular disease risk factors are put in place to reduce excess mortality.
What's new?
Diabetes mellitus increases the risk of cardiovascular disease and all‐cause mortality. There is clear evidence that diabetic foot ulceration, a common problem in long‐standing diabetes increases risk of death further still.
In this systematic review we have updated the meta‐analysis by Brownrigg et al. (2012), including almost half a million participants. We pooled study‐specific estimates using random‐effects meta‐analysis to ascertain risk of death in people with diabetes who developed foot ulceration vs those who did not. We conclude that, in the presence of diabetes, people with ulcers have an excess rate of all‐cause mortality as compared to those without any foot complications.
The presence of diabetic foot ulceration should be viewed as a major red flag for an increased disease burden and a poor outcome, and therefore should be prevented. If foot ulceration occurs, close monitoring of those individuals is warranted.
Continued development of clinical services towards prevention, early intervention and multidisciplinary team management is an appropriate strategy to reduce the burden in individuals with diabetes.</abstract><cop>England</cop><pub>Wiley Subscription Services, Inc</pub><pmid>31613404</pmid><doi>10.1111/dme.14151</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0002-9537-4050</orcidid></addata></record> |
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| source | MEDLINE; Access via Wiley Online Library |
| subjects | Cardiovascular diseases Cause of Death Diabetes Diabetes mellitus Diabetes Mellitus - epidemiology Diabetic Foot - epidemiology Feet Foot diseases Health risk assessment Humans Leg ulcers Meta-analysis Mortality Prognosis Risk factors Ulcers |
| title | Foot ulceration and its association with mortality in diabetes mellitus: a meta‐analysis |
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